Overreaching dietary restrictions coupled with athletic pursuits: Dangers of extreme calorie reduction in sports.
Train Smart: Avoiding Relative Energy Deficiency in Sport (RED-S)
Kickstarting your preparation for an event, like the Seattle Marathon, requires sufficient calorie intake tailored to the energy expended during training. Failure to do so may set you up for trouble.
"low energy availability refers to not replenishing the calories burned during exercise," says Sarah Gustafson, M.P.T., a physical therapist at the UW Medicine Sports Medicine Center at Husky Stadium. This condition, known as RED-S, has gained attention in the world of sports since it was introduced by the International Olympic Committee Medical Commission in 2014.
A Menace Across the Board
Initially, the term "female athlete triad" captured the attention of the sports community, focusing on female athletes experiencing low energy availability, menstrual irregularities, and decreased bone density.
However, the coining of the term RED-S in 2014 signified a shift, making it clear that this condition affects all athletes, not just women.
When an athlete’s body experiences energy deficiency, it impedes normal bodily functions, which, over time, can severely impact both their health and performance.
Who's At Risk and Why?
Athletes competing in sports entailing high energy demands, weight-class categorization, or aesthetic appeal are more prone to RED-S. Examples include:
- Distance Running: Competitors in distance running seek to minimize body fat for improved performance, putting them at risk if they do not consume adequate calories.
- Weight-Class Sports (e.g., wrestling, gymnastics): These sports demand athletes to maintain a specific body weight, often driving them to adopt restrictive eating behaviors to achieve or sustain weight goals.
- Aesthetic Sports (e.g., figure skating, dance, synchronized swimming): The emphasis on appearance can compel athletes to drastically restrict their diet, risking energy availability.
- Cycling: Similar to distance running, cyclists concentrate on maintaining a lean physique to optimize power-to-weight ratios, which could lead to inadequate energy intake.
- Gymnastics: The sport's emphasis on strength, flexibility, and appearance often results in eating disorder behaviors among athletes.
Other sports such as boxing, wrestling, or rowing where weight-class athletes need to meet competition weight requirements are also at risk.
Consequences of RED-S
The results of RED-S are far-reaching and adverse, impacting both an athlete's health and performance. Potential medical complications include:
- Increased risk of stress fractures
- Unhealthy cardiovascular changes that raise the risk of cardiovascular diseases
- Increased susceptibility to infections
- Multiple hormonal and metabolic abnormalities
Even if an athlete does not recognize the medical complications, they will likely notice their performance decline. Sometimes, an athlete or coach fails to recognize the signs of RED-S, leading to continued training without adequate dietary adjustments.
Some athletes may have to temporarily or permanently withdraw from their sport due to the repercussions of RED-S. The long-term health implications for young men and women are still not entirely understood, but potential harm remains a concern.
Warning Signs
Athletes displaying the following signs may be at risk for RED-S:
- Disordered eating: excessive calorie restriction, strict dieting, fear of dietary fat
- Unhealthy weight control practices: binging/purging, use of laxatives or appetite suppressants
- Excessive exercise beyond sensible training limits
- Low self-esteem or negative body image
- Self-critical and perfectionistic tendencies
- Poor coping mechanisms, struggle to handle emotional or psychological stress
- Irregular, fewer, or absent periods in women
- A history of recurrent stress fractures or fractures from minor injuries
Supporting Those at Risk
Whether you're a coach, parent, or friend, being aware of the potential risks of RED-S, particularly in sports that emphasize low body weight, is crucial. RED-S can be challenging to detect, but characteristics such as a focus on weight loss, disordered eating, and preoccupation with leanness may indicate problems.
Coaches, parents, and supporters can emphasize the importance of health and nutrition to enhance performance. They can also shift focus away from leanness and weight, encouraging healthy, sustainable lifestyle changes.
Seeking Help for RED-S
Individuals struggling with RED-S may deny having a problem or may be unaware that their behaviors put them at risk. A concerned loved one or coach may need to intervene in some cases. Treatment often necessitates a multidisciplinary approach, involving a physician, nutritionist, psychologist, and support from family, friends, teammates, and coaches. Athletes will have to adopt new, sustainable nutritional and exercise habits to support optimal health and performance.
"Eventually, those struggling with RED-S must realize that changes need to be made – that the current path is neither healthy nor sustainable," says Gustafson.
- To maintain optimal health and performance during training for events like the Seattle Marathon, it's crucial to ensure a healthy weight by adopting proper nutrition and exercise routines.
- RED-S, or Relative Energy Deficiency in Sport, impacts all athletes, not just women, and can be triggered by a variety of sports, including distance running, weight-class sports, aesthetic sports, cycling, gymnastics, boxing, and rowing.
- RED-S poses serious health risks such as increased risk of stress fractures, unhealthy cardiovascular changes, increased susceptibility to infections, and multiple hormonal and metabolic abnormalities.
- Coaches, parents, and friends can play a significant role in supporting athletes at risk of RED-S by encouraging a focus on health and nutrition instead of lean appearance, and seeking professional help when necessary.
